INTRODUCTION

“Nothing can be said to be certain except death and taxes.” Had Benjamin Franklin lived two centuries later, he might have cared to add a third—anesthesia with nausea. It is almost an expectation by both patients with health professionals alike that nausea and vomiting follow general anesthesia: it is the “big little problem,” it “goes with the territory.” Can anesthesiologists honestly conceive of a day when the emesis basin in the PACU is relegated to the museum? Perhaps not, but how far are anesthesiologists moving toward that halcyon day, and exactly just how serious are anesthesiologists about preventing or even treating postoperative nausea and vomiting (PONV)? Just how close are anesthesiologists to “zero tolerance” using what is currently available? Just how often is the full panoply of the available antiemetics prescribed, and just how often are those that are prescribed administered in a timely fashion and by an appropriate route? Just exactly how seriously are anesthesiologists interested in eliminating PONV?

The risk of PONV is generally conceived as an attribute of the patient with subsidiary risks attached to the context, that is, the drugs and operation. However, drugs themselves have no executive power. Additionally, it is unusual for a patient scheduled for elective surgery to enter the theater suite with preoperative nausea and vomiting. The uncomfortable reality surely must be that the major risk factor for the presence or absence of PONV is the choice of the anesthesiologist.